New antidepressants can increase risks for elderly, study suggests

ScienceDaily (Aug. 3, 2011) — Older people taking new generation antidepressants are at more risk of dying or suffering from a range of serious health conditions including stroke, falls, fractures and epilepsy, suggests a new study involving researchers at The University of Nottingham.

The research, published on the British Medical Journal website, discovered that selective serotonin reuptake inhibitors (SSRIs) are more strongly associated with an increased risk of several adverse outcomes in people over the age of 65 with depression compared with older tricyclic antidepressants (TCAs).

The authors say the risks and benefits of different antidepressants should be carefully considered when prescribing these drugs to elderly patients and have called for further research to investigate the findings.

Dr Carol Coupland, Associate Professor in Medical Statistics in The University of Nottingham's Division of Primary Care said: "We've found some evidence from our study that the older tricyclic antidepressants may be associated with lower risks of several adverse outcomes compared with newer antidepressants in older people diagnosed as having depression.

"This was an unexpected finding, and so further research using other data sources is needed to confirm these findings as well as provide more evidence on the benefits of different antidepressants in this group of people."

Depression is a common condition in older people and antidepressants -- particularly SSRIs -- are widely used. However, very little is known about the safety of these drugs in older people.

The team of researchers from the Universities of Nottingham and East Anglia set out to investigate the potential link between antidepressant treatment and the risk of a number of potentially life-threatening outcomes in older people.

They identified 60,746 UK patients aged 65 and over with a newly diagnosed episode of depression between 1996 and 2007 using the QResearch primary care database. Many patients had other conditions, such as heart disease and diabetes, and were taking several medications.

Patients were tracked until the end of 2008. During this time, 89 per cent (54,038) received at least one prescription for an antidepressant, and a total of 1,398,359 prescriptions for antidepressants were received. Of these 57 per cent were for SSRIs, 31 per cent for TCAs, 0.2 per cent for monoamine oxidase inhibitors (MAOIs) and 13.5 per cent for other antidepressants.

Antidepressant use was then analysed against several adverse outcomes including all-cause mortality, attempted suicide or self harm, heart attack, stroke, falls, fractures, epilepsy or seizures and high salt levels in the blood (hyponatraemia).

After adjusting for factors that could affect the results, including age, sex, severity of depression, other illnesses and use of other medications, the team found that SSRIs and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with TCAs.

Those taking SSRIs were more likely to die, suffer a stroke, fall or fracture, have epilepsy or a seizure and have hyponatraemia compared with TCAs. The group of other antidepressants were associated with an increased risk of mortality, attempted suicide or self-harm, stroke, fracture and epilepsy or seizures.

Patients in the study had a seven per cent risk of dying over one year while they were not taking antidepressants, while the comparable risks were 8.1 per cent when taking TCAs, 10.6 per cent for SSRIs and 11.4 per cent for the group of other antidepressants. For stroke, one-year risks were 2.3 per cent, 2.6 per cent and three per cent (compared with 2.2 per cent when not on antidepressants) and for fracture they were 2.2 per cent, 2.7 per cent and 2.8 per cent compared with 1.8 per cent.

Among individual drugs trazodone, mirtazapine and venlafaxine carried the highest risk for some adverse outcomes.

Rates of most adverse outcomes were highest in the 28 days after starting the antidepressant and also in the 28 days after stopping.

The authors also point out that TCAs were prescribed at lower doses than SSRIs and other antidepressant drugs, which they say "could in part explain our findings." They also caution that differences between patients prescribed different antidepressant drugs may account for some of the associations seen in the study, underlining the need for further research to confirm the findings.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Nottingham, via AlphaGalileo.

Journal Reference:

C. Coupland, P. Dhiman, R. Morriss, A. Arthur, G. Barton, J. Hippisley-Cox. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ, 2011; 343 (aug02 1): d4551 DOI: 10.1136/bmj.d4551

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Inpatient hospitalization rates appear to have increased among children and adolescents with psychiatric disorders, but decreased among elderly

ScienceDaily (Aug. 1, 2011) — Over a 10-year period, rates of short-stay inpatient hospitalizations increased for children and adolescents but decreased for elderly who had a primary psychiatric diagnosis, according to a report published Online First today by Archives of General Psychiatry, one of the JAMA/Archives journals. The article also finds the proportion of inpatient days paid for by private health insurance appeared to decline among children, adolescents and adults.

According to background information in the article, inpatient care for psychiatric conditions in short-stay settings increased from 1970 through the 1990s as long-term psychiatric hospitalization decreased. Since then, payers have reduced expenditures in these acute care settings and mental health policy makers and advocates have emphasized treatment alternatives with less restrictiveness and less negative stigma. Between 1990 and 2000, admissions to U.S. inpatient psychiatric services declined, but various data have suggested an increase in more recent years.

Joseph C. Blader, Ph.D., from the Stony Brook University School of Medicine, State University of New York, Stony Brook, evaluated trends in acute care hospitalizations for primary psychiatric diagnoses between 1996 and 2007, segmented by patient-level variables. He used demographic, clinical and payment data from the National Hospital Discharge Survey on a probability sample of discharges from short-stay facilities. Patients included in the study had a primary psychiatric diagnosis and were classified as children (ages 5 to 13 years), adolescents (ages 14 to 19 years), adults (ages 20 to 64 years) or elderly individuals (ages 65 years and older). Payers were classified as private, government or other (self-pay, no charge and other payment).

The study found increases in discharges for children and adolescents, as well as more moderate increases for adults, while discharge rates for elderly patients declined. However, the total inpatient days increased from 1,845 days per 100,000 in 1996 to 4,370 days in 2007 for children and from 5,882 days per 100,000 in 1996 to 8,247 days in 2007 for adolescents; again, a decrease was seen among elderly individuals, from 10,348 days per 100,000 in 1996 to 6,517 in 2007. Also, during the years studied, the proportion of inpatient days covered by private payers decreased among children, adolescents, and adults. Through the period surveyed, primary diagnoses of bipolar disorder increased and primary diagnoses of anxiety decreased.

"In conclusion, a substantial increase in acute care psychiatric hospitalization rates and inpatient occupancy for children and adolescents, a moderate increase in the hospitalization rate of adults, and a steep decline for elderly individuals represent significant developments in mental health treatment in the United States with potentially strong ramifications for quality of care and service financing," writes Blader. "Investigation of the clinical and organizational determinants of these trends, and their impact on patient outcomes, are vital to understanding their implications."

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

Joseph C. Blader. Acute Inpatient Care for Psychiatric Disorders in the United States, 1996 Through 2007. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2011.84

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Small hippocampus associated with depression in the elderly: Risk factor or shrinkage?

ScienceDaily (July 22, 2011) — Imaging studies have repeatedly found that people with depression have smaller hippocampal volumes than healthy individuals. The hippocampus is a brain region involved in learning and memory, spatial navigation, and the evaluation of complex life situations or "contexts." However, because in prior studies hippocampal volume was only measured in people once they became depressed, it has been unclear whether a small hippocampus renders a person vulnerable to developing depression, or whether it is a consequence of depression.

A new study published in Biological Psychiatry has approached that problem by following a large population of elderly individuals over a 10 year period.

Researchers performed an initial imaging scan on subjects to obtain a baseline measurement of their hippocampal volume and then performed follow-up scans 5 and 10 years later. During this time, they also repeatedly assessed the individuals for both depressive symptoms and depressive disorders.

Corresponding author Dr. Tom den Heijer explains their findings: "We found that persons with a smaller hippocampus were not at higher risk to develop depression. In contrast, those with depression declined in volume over time. Our study therefore suggests that a small hippocampal volume in depressed patients is more likely an effect of the depression rather than a cause."

"The principal importance of this type of research is that it may provide insight into age-related impairments in the function of the hippocampus," reflected Dr. John Krystal, Editor of Biological Psychiatry. "For example, in Alzheimer's disease, memory problems and disorientation are prominent symptoms, reflecting among other things the impaired function of the hippocampus."

Future studies will be needed to better understand whether current treatments protect the hippocampus and hippocampal function.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Elsevier, via AlphaGalileo.

Journal Reference:

Tom den Heijer, Henning Tiemeier, Hendrika J. Luijendijk, Fedde van der Lijn, Peter J. Koudstaal, Albert Hofman, Monique M.B. Breteler. A Study of the Bidirectional Association Between Hippocampal Volume on Magnetic Resonance Imaging and Depression in the Elderly. Biological Psychiatry, 2011; 70 (2): 191 DOI: 10.1016/j.biopsych.2011.04.014

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here sciencedaily.com

Small hippocampus associated with depression in the elderly: Risk factor or shrinkage?

ScienceDaily (July 22, 2011) — Imaging studies have repeatedly found that people with depression have smaller hippocampal volumes than healthy individuals. The hippocampus is a brain region involved in learning and memory, spatial navigation, and the evaluation of complex life situations or "contexts." However, because in prior studies hippocampal volume was only measured in people once they became depressed, it has been unclear whether a small hippocampus renders a person vulnerable to developing depression, or whether it is a consequence of depression.

A new study published in Biological Psychiatry has approached that problem by following a large population of elderly individuals over a 10 year period.

Researchers performed an initial imaging scan on subjects to obtain a baseline measurement of their hippocampal volume and then performed follow-up scans 5 and 10 years later. During this time, they also repeatedly assessed the individuals for both depressive symptoms and depressive disorders.

Corresponding author Dr. Tom den Heijer explains their findings: "We found that persons with a smaller hippocampus were not at higher risk to develop depression. In contrast, those with depression declined in volume over time. Our study therefore suggests that a small hippocampal volume in depressed patients is more likely an effect of the depression rather than a cause."

"The principal importance of this type of research is that it may provide insight into age-related impairments in the function of the hippocampus," reflected Dr. John Krystal, Editor of Biological Psychiatry. "For example, in Alzheimer's disease, memory problems and disorientation are prominent symptoms, reflecting among other things the impaired function of the hippocampus."

Future studies will be needed to better understand whether current treatments protect the hippocampus and hippocampal function.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Elsevier, via AlphaGalileo.

Journal Reference:

Tom den Heijer, Henning Tiemeier, Hendrika J. Luijendijk, Fedde van der Lijn, Peter J. Koudstaal, Albert Hofman, Monique M.B. Breteler. A Study of the Bidirectional Association Between Hippocampal Volume on Magnetic Resonance Imaging and Depression in the Elderly. Biological Psychiatry, 2011; 70 (2): 191 DOI: 10.1016/j.biopsych.2011.04.014

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

View the original article here